INCREASING ACTIVITY-STIMULATING BEHAVIOR IN DUTCH HOME CARE: FEASIBILITY OF THE SELF-PROGRAM

Abstract The concept of aging-in-place has become increasingly popular worldwide, including the Netherlands. However, as individuals age, their ability to perform activities of daily living often declines leading towards a need for homecare. Unfortunately, staff often unnecessarily take over care tasks and thereby potentially accelerate older adults’ functional decline. SELF is an interactive, tailored, holistic and theory-grounded training program consisting of 7 sessions spread over a period of 14 weeks, which aims to change staffs’ behavior towards more activity stimulating behavior. The program was evaluated in a cluster-randomized trial in Dutch nursing homes. However, its feasibility in the homecare setting was not yet known. Therefore, a feasibility study in one Dutch homecare team was conducted using a mixed-methods approach combining quantitative (i.e. checklist, logbooks, attendance forms and questionnaires) and qualitative data (i.e. focus group interviews) among program participants, team manager, coaches and trainers. Data was collected based on the three main pillars of the MRC framework: implementation, mechanisms of impact and contextual factors. In total, 24 staff members participated in the study, who delivered care to 145 clients. The SELF-program was largely implemented as intended, resulting in positive changes in staff knowledge, self-efficacy, and skills. However, contextual factors influenced the implementation of activity stimulating behaviour in practice. While reporting in electronic patient records and manager support were identified as facilitators, resistance from clients, bad expectation management by hospitals and GPs and time constraints acted as barriers. Overall, the SELF-program was feasible in Dutch homecare and only small program modifications are needed.

Maastricht University,Care and Public Health Research Institute,Maastricht,Limburg,Netherlands,3. Maastricht University,Maastricht,Limburg,Netherlands,4. Leiden University Medical Center,Leiden,Netherlands,5. Radboud University Medical Center,Nijmegen,Gelderland,Netherlands For frail older people it is evident to maintain their functional abilities and independence.Nursing staff are in a key position to encourage older people's independence and stimulate their engagement in functional activity.However, nurses tend to take over tasks frequently thereby depriving older people's remaining abilities.Clearly nurses need support to optimize their activity encouragement behavior.The Function-Focused Care based 'SELF-program' was developed based on lessons learned and implications from previous programs.SELF is an interactive, tailored, holistic and theory-grounded training program consisting of 7 seven sessions spread over a period of 3 months which aims to improve nurses' activity encouragement behavior and in turn client's self-reliance in daily activities.The program was subjected to a clusterrandomized trial in Dutch nursing home care which aimed to evaluate the program's effectiveness.The MAINtAIN and GARS-5 questionnaires were applied to assess the effectiveness on nurses' activity encouragement behavior and clients' self-reliance.28 wards from three care organizations across the Netherlands were recruited and randomized to the SELFprogram or care as usual.287 nurses and 241 geriatric clients participated.Measurements took place at baseline, directly after implementing the SELF-program (three months) and 9 months after baseline.Mixed linear regression demonstrated that nurses' activity encouragement behavior significantly improved (p=.004; ES=.05).At client level, no effects were found (p=.09; ES=.13).However, a trend towards slower decline in self-reliance was observed for those clients allocated to the SELF-program condition.The SELF-program was effective in improving nurses' behavior, however, effects were not translated to client populations.

INCREASING ACTIVITY-STIMULATING BEHAVIOR IN DUTCH HOME CARE: FEASIBILITY OF THE SELF-PROGRAM
Silke Metzelthin 1 , Lotte Hermens 2 , Getty Huisman -De Waal 3 , Stan Vluggen 4 , Janneke Man -van Ginkel 5 , and Sandra Zwakhalen 2 , 1. Maastricht University, Care and Public Health Research Institute,Maastricht,Limburg,Netherlands,2. Maastricht University,Maastricht,Limburg,Netherlands,3. Radboud University Medical Center,Nijmegen,Gelderland,Netherlands,4. Zuyd Hogeschool University of Applied Sciences,Kerkrade,Limburg,Netherlands,5. Leiden University Medical Center,Leiden,Netherlands The concept of aging-in-place has become increasingly popular worldwide, including the Netherlands.However, as individuals age, their ability to perform activities of daily living often declines leading towards a need for homecare.Unfortunately, staff often unnecessarily take over care tasks and thereby potentially accelerate older adults' functional decline.SELF is an interactive, tailored, holistic and theory-grounded training program consisting of 7 sessions spread over a period of 14 weeks, which aims to change staffs' behavior towards more activity stimulating behavior.The program was evaluated in a cluster-randomized trial in Dutch nursing homes.However, its feasibility in the homecare setting was not yet known.Therefore, a feasibility study in one Dutch homecare team was conducted using a mixed-methods approach combining quantitative (i.e.checklist, logbooks, attendance forms and questionnaires) and qualitative data (i.e.focus group interviews) among program participants, team manager, coaches and trainers.Data was collected based on the three main pillars of the MRC framework: implementation, mechanisms of impact and contextual factors.In total, 24 staff members participated in the study, who delivered care to 145 clients.The SELF-program was largely implemented as intended, resulting in positive changes in staff knowledge, self-efficacy, and skills.However, contextual factors influenced the implementation of activity stimulating behaviour in practice.While reporting in electronic patient records and manager support were identified as facilitators, resistance from clients, bad expectation management by hospitals and GPs and time constraints acted as barriers.Overall, the SELF-program was feasible in Dutch homecare and only small program modifications are needed.The benefits of physical activity during hospitalization are particularly relevant for older adults living with dementia, as these individuals are at the greatest risk for functional decline, delirium, behavioral symptoms associated with dementia, increased length of stay, adverse events increased readmissions and institutionalization post discharge.One effective way to engage these patients in physical activity is through implementation of a function focused philosophy of care.Function focused care helps nurses to evaluate patient's underlying physical capability and motivate them to participate in all care activities.The Function Focused Care for Acute Care Using the Evidence Integration Triangle study is a randomized controlled theoretically based trial that includes four components include: (1) Development of a Stakeholder Team; (2) Education of Staff; (3) Development of a Function Focused Care careplan; and (4) Mentoring and Motivating of Staff and Patients.Those randomized to control were exposed to education about Function Focused Care only.To date a total of 10 hospitals and 365 patients living with dementia have participated in the study.The mean age is 82, and the majority are female (62%) and white (72%).Although not statistically significant, there is evidence of improvement in the number of care interactions in which patients participated in the treatment versus control group.Cognition, quality of care interactions, behavioral and psychological symptoms associated with dementia, comorbidities, physical resilience, tethers and pain were all indirectly associated with performance of function focused care through performance of activities of daily living and/or pain.

BEHAVIORAL CHANGES OF NURSING STAFF AFTER A COACHING-BASED PSYCHOSOCIAL PROGRAM SUPPORTING SELF-DIRECTION IN PLWD
Maud Graff, Phebe Das, Gebrich Douma, Lieve Roets, and Hanneke Donkers, Radboud University Medical Center, Nijmegen, Gelderland, Netherlands The psychosocial person-centred intervention "SOCAVin-primary-care" (SOCAV-PC) offers training and reflective peer-coaching to nursing staff and training and personcentred care-planning to caregivers.SOCAV-PC aims to support persons with dementia (PwD) to maintain/improve their self-direction and daily functioning in meaningful activities with support of their caregivers.This study presents the experiences of the PwD, and changes in attitudes and behaviour of caregivers and nursing staff when following SOCAV.Spread over nine months, caregivers and nursing staff were trained and coached in the person-centred approach by a trained SOCAV-peer coach.Content analysis was performed using qualitative data derived from (1) intervention and coaching diaries from nursing staff, (2) coaching diaries of peer coaches, (3) focus groups among nursing staff, and (4) individual interviews with PwD and their caregivers.PwD felt heard and respected in making their own choices.Caregivers became more aware of the influence of their own behaviour on the mood of the PwD, and started trying to convert their controlling behaviour, meant to provide safety, into supporting wishes and needs of PwD.Among nursing staff, an ongoing process of positive changes in attitudes and behaviours towards person-centred care emerged: from acting on intuition and automatisms, towards learning to reflect on the behaviour of PwD and their own actions.Moreover, they gained a better understanding of the concept of self-direction, and discovered the power of conversation and observation through a more open attitude and behavioural change.Reflective coaching is an essential tool to enhance person-centred attitudes and behaviour among nursing staff.

THE NIH STAGE MODEL AND STUDY EXAMPLES OF EARLY STAGES IN
DEMENTIA CARE INTERVENTION DEVELOPMENT RESEARCH Chair: Debra Dobbs Discussant: Hongdao Meng The NIH's Stage Model provides a common language to facilitate discussion of intervention development research.According to NIH Stage Model (2022), "an examination of the mechanisms of behavior change or the principles underlying an intervention is encouraged by the NIH Stage Model in every Stage of behavioral intervention development."The five papers in this symposium focus on earlystage intervention development by refinement, adaptation and pilot testing (Stage 1) related to dementia and palliative care (PC) clinical trials.The first paper is a cluster trial of a PC education program for nurses (N=23) in 10 assisted living communities that tested the mechanism of staff self-efficacy in increases in advance care planning discussions with family members of residents living with dementia.The second paper

FOCUSED CARE FOR ACUTE CARE USING THE EVIDENCE INTEGRATION TRIANGLE: IMPACT OF PATIENT CARE ACTIVITIES Elizabeth
Galik 1 , Barbara Resnick 2 , and Marie Boltz 3 , 1.